Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial

Antonio Cano-Vindel; Roger Muñoz-Navarro; Juan A Moriana; Paloma Ruiz-Rodríguez; Leonardo Adrián Medrano; César González-Blanch

doi:10.1017/S0033291720005498

Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial

Psychol Med. 2021 Feb 8;52(15):1-13. doi: 10.1017/S0033291720005498. Online ahead of print.

Authors

Antonio Cano-Vindel¹, Roger Muñoz-Navarro², Juan A Moriana³, Paloma Ruiz-Rodríguez⁴, Leonardo Adrián Medrano⁵, César González-Blanch⁶

Affiliations

¹ Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223Madrid, Spain.
² Department of Psychology and Sociology, Faculty of Social and Human Sciences, University of Zaragoza, C/Cdad. Escolar, S/N, 44003, Teruel, Spain.
³ Department of Psychology, University of Córdoba/ Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital, Av. Menéndez Pidal, s/n, 14004Córdoba, Spain.
⁴ Castilla La Nueva Primary Care Centre, Health Service of Madrid, Calle Teruel, 4, 28941Fuenlabrada, Madrid, Spain.
⁵ Faculty of Psychology, University Siglo 21, De los Latinos 8555, 5008Córdoba, Argentina.
⁶ Mental Health Centre, University Hospital "Marqués de Valdecilla"- IDIVAL, Av. Valdecilla, 25, 39008Santander, Cantabria, Spain.

Abstract

Background: Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients.

Methods: A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8-10 patients) delivered over a 12-14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed.

Results: Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p < 0.001; Morris's d = -0.65; depression: p < 0.001; d = -0.58, and somatic symptoms: p < 0.001; d = -0.40). These effects were sustained at the 12-month follow-up (anxiety: p < 0.001; d = -0.44; depression: p < 0.001; d = -0.36 and somatic symptoms: p < 0.001; d = -0.32). The transdiagnostic group also had significantly better outcomes on functioning (d = 0.16-0.33) and quality of life domains (d = 0.24-0.42), with sustained improvement at the 12-month follow-up in functioning (d = 0.25-0.39) and quality of life (d = 0.58-0.72). Reliable recovery rates showed large between-group effect sizes (d > 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up.

Conclusions: Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care.

Trial registration: isrctn.org identifier: ISRCTN58437086.

Keywords: Anxiety; depression; emotional disorders; group psychotherapy; randomized clinical trial; somatization; transdiagnostic.